Health insurance coverage in the United States

Harris County Commissioner Adrian Garcia says local property tax increases stem largely from federal and state policy decisions rather than county spending. He points to Texas's continued refusal to expand Medicaid under the Affordable Care Act, which has forfeited more than $184 billion in federal funds since 2016, according to the Urban Institute, leaving Harris Health, the county's safety-net hospital system, to absorb costs for uninsured patients.

Garcia also cites federal Medicaid cuts under Trump's tax and spending legislation, which the Kaiser Family Foundation estimates will reduce federal Medicaid spending by $911 billion over a decade, potentially adding 10 million uninsured Americans per the Congressional Budget Office. Harris Health reported $179 million in added indigent care costs last year. A new state law exempting billions in business property from taxation, plus unfunded state mandates on elections and courts despite a $24 billion state surplus, further shift costs to homeowners, Garcia argues, even as county leaders work to control spending.